Surgery:

Surgery is usually the first step in treating most brain tumors. In some cases, however, such as most brain stem gliomas and other tumors located deep inside the brain, it may be too dangerous to perform surgery. The object of most brain tumor surgeries is to remove or reduce as much of its bulk as possible. By reducing the size, other therapies, particularly radiotherapy, can be more effective.

Craniotomy

The standard procedure is called craniotomy.

• The neurosurgeon removes a piece of skull bone to expose the area of brain over the tumor.
• The tumor is located and then removed.

There are various surgical options for breaking down and removing the tumor. They include:

• Standard surgical procedures
• Laser microsurgery (which produces great heat and vaporizes tumor cells)
• Ultrasonic aspiration (which uses ultrasound to break the glioma tumor into small pieces, which are then suctioned out)

Relatively benign, grade I gliomas may be treated only by surgery. Most malignant tumors require additional treatments, including repeat surgery.

Imaging techniques, such as CT and MRI, are used along with surgery to help map the area of the tumor in the brain.

The neurosurgeon's skill in removing the tumor as completely as possible is critical to survival. No one should be shy about asking the surgeon the number of similar procedures they have performed. (Asking for complication rates may not be useful, since a very experienced surgeon might operate on many high-risk patients.)

Shunt Placement

Sometimes a brain tumor can create blockage and cerebrospinal fluid accumulates excessively in the skull, causing increased intracranial pressure. In these cases, a surgeon may implant a ventriculoperitoneal shunt (VP) to help drain the fluid. The procedure involves placing a small catheter into a brain ventricle. Another catheter is tunneled into the abdominal (peritoneal) cavity. A pump that controls the flow of fluid is attached to both catheters.

Risks and Complications of Surgery

The most serious concern of brain surgery is preserving brain function. Surgeons will try to be conservative in their approach so as to limit removing tissue that may cause a loss of function. Bleeding and blood clots are other complications. (The blood-thinning drug heparin may be given at the time of surgery to prevent blood clots.) Postsurgical complications include swelling in the brain, which is typically treated with corticosteroid drugs.